Change Birth Feeding & Vaccination _ Flourish Child.html

Kago Kethobile, 17/09/2024 11:14

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                Welcome,
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                <strong>Kago</strong>.
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                    <a href="https://flourish.bhp.org.bw/administration/">View site</a> /
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<a href="https://flourish.bhp.org.bw/admin/flourish_child/birthfeedingvaccine/">Birth Feeding &amp; Vaccinations</a>
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› B142-040990408-2-10 2000D.0
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      <div class="content">
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        <!-- Content -->
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        <div id="content" class="colM">
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          <h1>Change Birth Feeding &amp; Vaccination</h1>
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<div id="content-main">
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  <ul class="object-tools">
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<li>
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    <a href="https://flourish.bhp.org.bw/admin/flourish_child/birthfeedingvaccine/946481eb-df19-435c-88eb-e91735e266c7/history/" class="historylink">History</a>
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</li>
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<li><a href="https://flourish.bhp.org.bw/subject/child_dashboard/B142-040990408-2-10/b8da06c2-c8ba-4d9e-982a-02b5e6b87ef7/" class="viewsitelink">View on site</a></li>
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  </ul>
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<form method="post" id="birthfeedingvaccine_form" novalidate=""><input type="hidden" name="csrfmiddlewaretoken" value="0LGx14KBNDEm56VfYcAsE377rIWMMih6n3T8ipa9D9mSTQwaApUtTQOcgQT6xppN">
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<div>
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    <p class="errornote">
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    Please correct the error below.
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    </p>
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    <ul class="errorlist nonfield"><li>Participant has been taken offstudy. Cannot capture any new data.</li></ul>
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    <h5>Instructions:</h5><p>Please complete the form below. Required 
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questions are in bold. When all required questions are complete click 
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SAVE or, if available, SAVE NEXT. Based on your responses, additional 
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questions may be required or some answers may need to be corrected.</p>
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  <fieldset class="module aligned ">
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        <div class="form-row field-child_visit">
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                <div>
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                        <label class="required" for="id_child_visit"><a title="child_visit">1</a>. Child visit:</label>
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                            <div class="related-widget-wrapper">
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    <select name="child_visit" required="" id="id_child_visit">
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  <option value="">---------</option>
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  <option value="5487f8de-5d33-4585-8a0c-e9a54073b7ea" selected="selected">B142-040990408-2-10 2000D.0</option>
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</select>
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        <a class="related-widget-wrapper-link change-related" id="change_id_child_visit" data-href-template="/admin/flourish_child/childvisit/__fk__/change/?_to_field=id&amp;_popup=1" title="Change selected Child Visit" href="https://flourish.bhp.org.bw/admin/flourish_child/childvisit/5487f8de-5d33-4585-8a0c-e9a54073b7ea/change/?_to_field=id&amp;_popup=1"><img src="Change%20Birth%20Feeding%20&amp;%20Vaccination%20_%20Flourish%20Child_files/icon-changelink.svg" alt="Change"></a><a class="related-widget-wrapper-link add-related" id="add_id_child_visit" href="https://flourish.bhp.org.bw/admin/flourish_child/childvisit/add/?_to_field=id&amp;_popup=1" title="Add another Child Visit"><img src="Change%20Birth%20Feeding%20&amp;%20Vaccination%20_%20Flourish%20Child_files/icon-addlink.svg" alt="Add"></a>
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</div>
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                </div>
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        </div>
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        <div class="form-row field-report_datetime">
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                <div>
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                        <label class="required" for="id_report_datetime_0"><a title="report_datetime">2</a>. Report Date:</label>
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                            <p class="datetime">
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  Date: <input type="text" name="report_datetime_0" value="2024-09-17" class="vDateField" size="10" required="" id="id_report_datetime_0"><span class="datetimeshortcuts">&nbsp;<a href="#">Today</a>&nbsp;|&nbsp;<a href="#" id="calendarlink0"><span class="date-icon" title="Choose a Date"></span></a></span>
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<br>
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  Time: <input type="text" name="report_datetime_1" value="08:46:42" class="vTimeField" size="8" required="" id="id_report_datetime_1"><span class="datetimeshortcuts">&nbsp;<a href="#">Now</a>&nbsp;|&nbsp;<a href="#" id="clocklink0"><span class="clock-icon" title="Choose a Time"></span></a></span>
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</p><input type="hidden" name="initial-report_datetime_0" value="2024-09-17" id="initial-id_report_datetime_0"><input type="hidden" name="initial-report_datetime_1" value="08:46:42" id="initial-id_report_datetime_1">
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                        <div class="help">If reporting today, use today's date/time, otherwise use the date/time this information was reported.</div>
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                </div>
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        </div>
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        <div class="form-row field-feeding_after_delivery">
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                <div>
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                        <label class="required" for="id_feeding_after_delivery_0"><a title="feeding_after_delivery">3</a>. How was the infant being fed immediately after delivery? :</label>
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                            <ul id="id_feeding_after_delivery" class="radiolist">
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    <li><label for="id_feeding_after_delivery_0"><input type="radio" name="feeding_after_delivery" value="breastfeeding_only" class="radiolist" required="" id="id_feeding_after_delivery_0">
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 Breastfeed only</label>
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</li>
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    <li><label for="id_feeding_after_delivery_1"><input type="radio" name="feeding_after_delivery" value="Formula feeding only" class="radiolist" required="" id="id_feeding_after_delivery_1" checked="checked">
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 Formula feeding only</label>
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    <li><label for="id_feeding_after_delivery_2"><input type="radio" name="feeding_after_delivery" value="Both breastfeeding and formula feeding" class="radiolist" required="" id="id_feeding_after_delivery_2">
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 Both breastfeeding and formula feeding</label>
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    <li><label for="id_feeding_after_delivery_3"><input type="radio" name="feeding_after_delivery" value="Medical complications: Infant did not feed" class="radiolist" required="" id="id_feeding_after_delivery_3">
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 Medical complications: Infant did not feed</label>
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</li>
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</ul>
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                        <div class="help"> ...before discharge from maternity</div>
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                </div>
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        </div>
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        <div class="form-row field-breastfeed_start_dt">
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                <div>
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                        <label for="id_breastfeed_start_dt"><a title="breastfeed_start_dt">4</a>. When did you begin breastfeeding your infant?</label>
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                            <input type="text" name="breastfeed_start_dt" class="vDateField" size="10" id="id_breastfeed_start_dt"><span class="datetimeshortcuts">&nbsp;<a href="#">Today</a>&nbsp;|&nbsp;<a href="#" id="calendarlink1"><span class="date-icon" title="Choose a Date"></span></a></span>
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                </div>
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        </div>
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        <div class="form-row field-breastfeed_start_est">
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                <div>
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                        <label for="id_breastfeed_start_est_0"><a title="breastfeed_start_est">5</a>. Is this date estimated?</label>
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                            <ul id="id_breastfeed_start_est" class="radiolist">
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    <li><label for="id_breastfeed_start_est_0"><input type="radio" name="breastfeed_start_est" value="" class="radiolist" id="id_breastfeed_start_est_0" checked="checked">
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 None</label>
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</li>
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    <li><label for="id_breastfeed_start_est_1"><input type="radio" name="breastfeed_start_est" value="gen_est" class="radiolist" id="id_breastfeed_start_est_1">
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 Yes - General estimation</label>
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    <li><label for="id_breastfeed_start_est_2"><input type="radio" name="breastfeed_start_est" value="used_infant_dob" class="radiolist" id="id_breastfeed_start_est_2">
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 Yes - Used infant date of birth</label>
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</li>
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    <li><label for="id_breastfeed_start_est_3"><input type="radio" name="breastfeed_start_est" value="No" class="radiolist" id="id_breastfeed_start_est_3">
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 No</label>
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</li>
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</ul>
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                </div>
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        </div>
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        <div class="form-row field-formulafeed_start_dt">
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                <div>
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                        <label for="id_formulafeed_start_dt"><a title="formulafeed_start_dt">6</a>. When did you begin feeding your infant formula?</label>
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                            <input type="text" name="formulafeed_start_dt" value="2022-02-19" class="vDateField" size="10" id="id_formulafeed_start_dt"><span class="datetimeshortcuts">&nbsp;<a href="#">Today</a>&nbsp;|&nbsp;<a href="#" id="calendarlink2"><span class="date-icon" title="Choose a Date"></span></a></span>
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        <div class="form-row field-formulafeed_start_est">
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                <div>
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                        <label for="id_formulafeed_start_est_0"><a title="formulafeed_start_est">7</a>. Is this date estimated?</label>
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                            <ul id="id_formulafeed_start_est" class="radiolist">
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    <li><label for="id_formulafeed_start_est_0"><input type="radio" name="formulafeed_start_est" value="" class="radiolist" id="id_formulafeed_start_est_0">
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 None</label>
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    <li><label for="id_formulafeed_start_est_1"><input type="radio" name="formulafeed_start_est" value="Yes" class="radiolist" id="id_formulafeed_start_est_1">
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 Yes</label>
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    <li><label for="id_formulafeed_start_est_2"><input type="radio" name="formulafeed_start_est" value="No" class="radiolist" id="id_formulafeed_start_est_2" checked="checked">
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 No</label>
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        <div class="form-row field-comments">
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                <div>
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                        <label for="id_comments"><a title="comments">8</a>. Comment if any additional pertinent information: :</label>
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                            <textarea name="comments" cols="40" rows="10" class="vLargeTextField" maxlength="250" id="id_comments">Not yet received birth vaccines
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child was formula fed immediately after delivery at NNU
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KMK
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17/09/2024</textarea>
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                </div>
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<div class="js-inline-admin-formset inline-group" id="birthvaccines_set-group" data-inline-type="tabular" data-inline-formset="{&quot;name&quot;: &quot;#birthvaccines_set&quot;, &quot;options&quot;: {&quot;prefix&quot;: &quot;birthvaccines_set&quot;, &quot;addText&quot;: &quot;Add another Birth Vaccines&quot;, &quot;deleteText&quot;: &quot;Remove&quot;}}">
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  <div class="tabular inline-related last-related">
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<input type="hidden" name="birthvaccines_set-TOTAL_FORMS" value="0" id="id_birthvaccines_set-TOTAL_FORMS" autocomplete="off"><input type="hidden" name="birthvaccines_set-INITIAL_FORMS" value="0" id="id_birthvaccines_set-INITIAL_FORMS"><input type="hidden" name="birthvaccines_set-MIN_NUM_FORMS" value="0" id="id_birthvaccines_set-MIN_NUM_FORMS" autocomplete="off"><input type="hidden" name="birthvaccines_set-MAX_NUM_FORMS" value="1000" id="id_birthvaccines_set-MAX_NUM_FORMS" autocomplete="off">
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<fieldset class="module ">
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   <h2>Birth Vaccines</h2>
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   <table>
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     <thead><tr>
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       <th class="original"></th>
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         <th class="column-vaccination required">Since delivery, did the child receive any of the following vaccinations
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         </th>
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         <th class="column-vaccine_date required">Date Vaccine was given
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         <th class="column-user_created">User created
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         <img src="Change%20Birth%20Feeding%20&amp;%20Vaccination%20_%20Flourish%20Child_files/icon-unknown.svg" class="help help-tooltip" width="10" height="10" alt="(Updated by admin.save_model)" title="Updated by admin.save_model">
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         </th>
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         <th class="column-user_modified">User modified
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         <img src="Change%20Birth%20Feeding%20&amp;%20Vaccination%20_%20Flourish%20Child_files/icon-unknown.svg" class="help help-tooltip" width="10" height="10" alt="(Updated by admin.save_model)" title="Updated by admin.save_model">
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         </th>
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         <th class="column-created">Created
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         </th>
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         <th class="column-modified">Modified
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         <th class="column-hostname_created">Hostname created
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         <img src="Change%20Birth%20Feeding%20&amp;%20Vaccination%20_%20Flourish%20Child_files/icon-unknown.svg" class="help help-tooltip" width="10" height="10" alt="(System field. (modified on create only))" title="System field. (modified on create only)">
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         </th>
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         <th class="column-hostname_modified">Hostname modified
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         <img src="Change%20Birth%20Feeding%20&amp;%20Vaccination%20_%20Flourish%20Child_files/icon-unknown.svg" class="help help-tooltip" width="10" height="10" alt="(System field. (modified on every save))" title="System field. (modified on every save)">
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         </th>
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     </tr></thead>
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     <tbody>
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        <tr class="form-row  empty-form" id="birthvaccines_set-empty">
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        <td class="original">
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          <input type="hidden" name="birthvaccines_set-__prefix__-id" id="id_birthvaccines_set-__prefix__-id">
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          <input type="hidden" name="birthvaccines_set-__prefix__-birth_feed_vaccine" value="946481eb-df19-435c-88eb-e91735e266c7" id="id_birthvaccines_set-__prefix__-birth_feed_vaccine">
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        </td>
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              <td class="field-vaccination">
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                  <select name="birthvaccines_set-__prefix__-vaccination" id="id_birthvaccines_set-__prefix__-vaccination">
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  <option value="" selected="selected">---------</option>
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  <option value="Vitamin_A">Vitamin A</option>
525

    
526
  <option value="BCG">BCG</option>
527

    
528
  <option value="Hepatitis_B">Hepatitis B</option>
529

    
530
  <option value="DPT">DPT (Diphtheria, Pertussis and Tetanus)</option>
531

    
532
  <option value="Haemophilus_influenza">Haemophilus Influenza B Vaccine</option>
533

    
534
  <option value="PCV_Vaccine">PCV Vaccine (Pneumonia Conjugated Vaccine)</option>
535

    
536
  <option value="Polio">Polio</option>
537

    
538
  <option value="inactivated_polio_vaccine">Inactivated-Polio Vaccine</option>
539

    
540
  <option value="Rotavirus">Rotavirus</option>
541

    
542
  <option value="Measles">Measles</option>
543

    
544
  <option value="Pentavalent">Pentavalent Vaccine (Contains DPT, Hepatitis B and Haemophilus Influenza B Vaccine)</option>
545

    
546
  <option value="diphtheria_tetanus">Diphtheria and Tetanus</option>
547

    
548
</select>
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              </td>
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              <td class="field-vaccine_date">
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                  <input type="text" name="birthvaccines_set-__prefix__-vaccine_date" class="vDateField" size="10" id="id_birthvaccines_set-__prefix__-vaccine_date"><span class="datetimeshortcuts">&nbsp;<a href="#">Today</a>&nbsp;|&nbsp;<a href="#" id="calendarlink3"><span class="date-icon" title="Choose a Date"></span></a></span>
560
              
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              </td>
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563
            
564
          
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566
          
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569
              <td class="field-user_created">
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                  <p></p>
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              </td>
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              <td class="field-user_modified">
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                  <p></p>
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583
              </td>
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587
            
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              <td class="field-created">
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591
                  <p>Sept. 17, 2024, 8:47 a.m.</p>
592
              
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              </td>
594
              
595
            
596
          
597
            
598
              
599
              <td class="field-modified">
600
              
601
                  <p>Sept. 17, 2024, 8:47 a.m.</p>
602
              
603
              </td>
604
              
605
            
606
          
607
            
608
              
609
              <td class="field-hostname_created">
610
              
611
                  <p>flourish</p>
612
              
613
              </td>
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615
            
616
          
617
            
618
              
619
              <td class="field-hostname_modified">
620
              
621
                  <p></p>
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623
              </td>
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627
        
628
        
629
        </tr>
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631
     <tr class="add-row"><td colspan="9"><a href="#">Add another Birth Vaccines</a></td></tr></tbody>
632
   </table>
633
</fieldset>
634
  </div>
635
</div>
636

    
637

    
638

    
639

    
640

    
641

    
642

    
643
    
644

    
645
  
646
<div class="submit-row">
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<input type="submit" value="Save" class="default" name="_save">
648

    
649
<input type="submit" title="Leave form without saving" value="Cancel" name="_cancel">
650
<input type="submit" title="Save and go to next form in schedule" value="Save and next" name="_savenext">
651
</div>
652

    
653

    
654
  
655

    
656

    
657
<footer class="footer">
658
  <div class="container">
659
    <span class="text-muted small text-center">
660
      <i class="fa fa-copyright"></i> 2010-2024&nbsp;Botswana-Harvard AIDS Institute&nbsp;&nbsp;
661
      <i class="fa fa-leaf"></i> Revision: &nbsp;&nbsp;
662
      <i class="fa fa-clock-o"></i> Africa/Gaborone&nbsp;&nbsp;
663
      <i class="fa fa-exclamation-circle"></i> For research purposes only.&nbsp;&nbsp;
664
    </span>
665
  </div>
666
</footer>
667

    
668

    
669

    
670

    
671

    
672

    
673
    <script id="django-admin-form-add-constants" src="Change%20Birth%20Feeding%20&amp;%20Vaccination%20_%20Flourish%20Child_files/change_form.js" async="">
674
    </script>
675

    
676

    
677

    
678

    
679
<script id="django-admin-prepopulated-fields-constants" src="Change%20Birth%20Feeding%20&amp;%20Vaccination%20_%20Flourish%20Child_files/prepopulate_init.js" data-prepopulated-fields="[]">
680
</script>
681

    
682

    
683
</div>
684
</form></div>
685

    
686
        <div class="overlay hide-loader" id="loader">
687
            <div class="overlay__inner">
688
                <div class="overlay__content">
689
                        <span class="spinner"></span>
690
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691
            </div>
692
        </div>
693

    
694
          
695
          <br class="clear">
696
        </div>
697
        <!-- END Content -->
698
        <div id="footer"></div>
699
      </div>
700
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701
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702
<!-- END Container -->
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704

    
705
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